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WHO Framework on integrated people-centred health services:
putting people and communities at the centre of health systems
Nuria Toro Polanco Service Delivery and Safety World Health Organization
Evolution of integrated people-centred care
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200
400
600
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1,000
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1,400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Number of participants in ICIC
Almere
Barcelona
Edinburgh
San Marino
Brussels
Berlin Vienna Dublin
Dublin
11th ICIC, Odense, 2011
69th World Health Assembly
Geneva, 2016
“ “Empowerment of individuals and communities in their
dealings with health services is imperative for better clinical outcomes and
universal access to quality services (Austria)”
“Health care systems should empower citizens, facilitate
continuity and coordination of care and address inequitable access” (Canada)
“The new campaign for people-centred health services mark a return to the principles of primary health care centred on the
family and the community” (Senegal)
“Putting patients first and providing increasing integration is one
way to ease the increasing strain on health services, and should be a priority for all
stakeholders” (Estonia on behalf of the Nordic and Baltic Countries)
Supporting a people-centred approach
.
Globally, over 400 million people lack access to essential health services that could be delivered through primary care (WHO, 2016)
In the Americas, only 22% of primary care providers consider that referral systems with other specialized care are working properly (WHO AMRO, 2010)
Half of all adults in the United States have difficulty understanding and acting upon health information, which end up in confusion and ineffective care (IOM, 2004)
In Africa, the level of involvement of communities in decision-making about how health services could be delivered was rated as poor by 45% of the population (WHO, 2012)
Challenges
“ .
Vision of the Framework on IPCHS
All people have equal access to quality health services that are co-produced in a way that meets their life course
needs and social preferences, are coordinated across the continuum of care and are comprehensive, safe, effective,
timely, efficient and acceptable; and all carers are motivated, skilled and operate in a supportive environment”
Five strategies
Engagement and empowerment
Engagement
Involving people and communities in the design, planning and delivery of health services that, for example, enable them to make choices about care and treatment options or to participate in strategic decision-making on how health resources should be spent.
The process of supporting people and communities to take control of their own health needs resulting, for example, in the uptake of healthier behaviors or the ability to self-manage illnesses.
Empowerment
Strategy 1. E & E Improving health literacy
Sharing decision-making between people & health professionals
Giving people access to personal health records
Supporting self-management
Promoting personal care
Fostering community participation
Boosting community awareness
Enhancing community delivered care
Harnessing patient and user groups
Addressing structural factors that marginalize at-risk communities
Improvement of patient
involvement in United States
Mobilizing communities to reduce maternal
and neonatal deaths in Malawi
Promoting HIV and TB
programmes to disadvantaged communities in
Kenya
Improved geographic access in Thailand
Engaging and empowering
women for better health in Nepal
Social participation in Tupiza, Bolivia
Health education “Skilled for health” in England
Reaching out to underserved
communities in Botswana
Promoting HIV/AIDS literacy
in Angola
Patient networks on dementia services in
Greece
Reducing health inequity in Namibia
Community-owned primary
care networks in Mali
Community engagement in
Ghana
Self-management of COPD through
tele-rehabilitation in
Denmark
Peer-delivered HIV community
services in Portugal
Many initiatives across all settings
Benefits for individuals & families • Better self-management of illness & control of risk factors associated
with lifestyle
• Reduced misdiagnosis
• Greater patient satisfaction and independence
• Reduced unnecessary hospital visits and/or hospital readmissions
• Improved care coordination and reduced costs
• Improved health status and quality of life
Benefits for communities • Help communities examine the underlying factors behind health problems
• Better access to care
• Care more responsive to community needs
• Greater engagement and participatory representation in decision-making about the use of health resources
• Increased legitimacy and trust
• Improved health outcomes
WHO support-listening to MS
WHO support to IPCHS
CE Framework. Work in progress
“People-centred health services must be fuelled by compassion, rather than by money.
We urge Member States to move towards people-centred health systems run
with warm hearts”
North Korea, WHA 2016